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By Dr. Kuvent, April 29, 2010 12:55 pm

Plantar fasciitis is a term that you’ve probably come across if you have dealt with heel pain in the past or have read much about it. Indeed, it is a major cause of symptoms, but unfortunately many patients and physicians often overlook the many other possible causes behind aching heels. One commonly misdiagnosed etiology is neurologic based heel pain.

          If you were to take a look at the anatomy of a human ankle, you’d notice that there are several major nerves running through the ankle and into the foot. At various locations these nerves branch to form even more nerves. Of course this is essential for our normal functioning as our feet not only contain many muscles but they are also very sensitive-which is a good thing! However, the space within the ankle and hind-foot is fairly narrow and occasionally one or more of those nerves can become compressed resulting in sore heels.

          One of the most common nerve entrapments creating heel pain involves a nerve which runs across the bottom of the heel towards the outside of the foot where it supplies a muscle of the 5^th toe. This nerve runs through a tight space where it can easily be compressed by a heel spur, the plantar fascia (central location of plantar fasciitis), and other structures. This type of pain is known as Baxter’s neuritis, and as opposed to plantar fasciitis, it will more often be painful following activities as compared to early morning or first-step pain.

          There are multiple other causes of neurologic pain in addition to a Baxter’s neuritis. For example, even irritation within the lower spine can create symptoms of pain at the heel. These symptoms may be difficult to distinguish from other causes, but it is generally more of a tingling, numbing, or burning sort of pain. Depending on your case, your local podiatrist may recommend several different diagnostic techniques after a thorough clinical exam if your pain is persistent. These may include X-rays, nerve-conduction studies, or an MRI to exclude any possible tumors or other space-occupying lesions.

          The treatment for neurologic heel pain depends upon its exact etiology and which specific nerves are affected. Initial treatments are often similar to those for plantar fasciitis and include the use of certain medications, mechanical supports, and anesthetic injections. If these measures are ineffective, surgical treatment usually involves a simple procedure in which a small incision is made at the bottom of the heel. The doctor then creates more space by removing some of the excess tissue which may be pressing against the nerve.

          In addition to nerve complications, there are many other possible causes of heel pain which should also be ruled out. If you have questions, feel free to contact your local foot doctor in Chandler today.

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By Dr. Kuvent, March 17, 2010 9:39 am

For most of us, losing fat is considered a goal, and something that many Americans strive for each year. However, when it comes to our feet, the reverse is true, and as we age the fat in our heels sometimes becomes thin and something to hold on to for as long as possible. Imagine driving a car in which the tire treads have worn thin, the air pressure is low, and the rims are nearly riding against the ground. The same principle occurs when the layer of fat beneath our ‘calcaneus’ or heel bone becomes worn down. Often times, this phenomenon is the cause for a great amount of heel pain.

          While it’s commonly thought that age is the cause of fat pad breakdown, there are also many other important causes and factors. Surgery, diabetic nerve problems, arthritic conditions, the use of steroids or steroid injections, and even a unique disorder known as Complex Regional Pain Syndrome can all lead to fat pad thinning. Of course, the way that we use our bodies can also play a big role. In the same way that cartilage tends to break down with overuse leading to knee and other problems, the cushioning fat pad of our heels can also wear out due to certain lifestyles, being overweight, or simply from genetics.

          Heel pain in general is a very broad topic which includes disorders of nerves, blood-flow, inflammation, metabolism, and even tumors. Therefore, it’s never a bad idea to visit your local Chandler foot doctor if you are having symptoms, because these other conditions can be properly ruled out. Fat pad atrophy may go on to cause stress fractures or various arthritic conditions, so a thorough evaluation including X-rays can indicate whether a more serious process is foreseeable.

          Much research is currently in the works regarding the injection of silicone and other synthetic materials to act as a near-natural replacement for fat pad loss. This may hold great promise in the future. For now, however, the gold standard of treatment continues to be specific shoe gear modifications, padding, and the use of customized inserts to provide optimal support to the heel bone. Feel free to discuss your best options with your podiatrist.

          Despite some of the natural changes that occur with aging, there are still some very viable options to keep you healthy and active. The best thing you can do for your overall well-being is to stay on your feet.

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By Dr. Kuvent, November 4, 2009 12:26 am

Many of us tend to think of spurs as being those old, pointed metal devices worn by cowboys on their heels in order to persuade (if that’s the right word) their horses into picking up the pace. You probably don’t think about it often, but many people are walking around today with intrinsic spurs coming off their actual heel bones! Unlike cowboy spurs, these spurs are made of bone and are actually a forward projection of the lower aspect of the “calcaneus” or heel bone. They play a unique and interesting role in the etiology of heel pain.

Much of the heel pain seen by podiatrists today is due to “plantar fasciitis” which is an inflammation of the connective tissue band running from the bottom of your heel to the base of your toes. Sitting just above and adjacent to the plantar fascia are numerous muscles which help the foot to maneuver. These structures are all closely attached to a small area on that front bottom part of the heel bone. As you might imagine, this creates a great amount of tension in that part of the heel, and over time the constant pulling of those soft tissues on the bone can lead to the development of a bony protrusion towards the direction of pull. Age, genetics, biomechanics, and other factors may all influence this phenomenon.

If you were to look at a foot model or an X-ray of a heel spur, you might be fairly surprised as they can get up to half an inch long and appear sharp-almost like a hook protruding from the heel. Actually, much of the pain involved is NOT due to the spur but rather to the inflamed soft tissues in the area. Thus, more often than not, treatment is aimed at relieving tension and irritation in the soft tissues as well as evaluating them for tears and other pathology.

Whether a spur is present or not, you should definitely visit your podiatrist if you’re having significant heel pain. He or she can evaluate it clinically and then order an X-ray or other test to see if spurring is actually present. A spur may in fact be causing the pain if it gets large enough and starts to compress on nerves in the area. The doctor can also evaluate the nature of the spur, which in some cases may help to rule out hormonal issues, arthritic disorders, and other systemic conditions. Furthermore, imaging and other diagnostic measures can help to indicate whether something else entirely-such as a fracture-is causing the pain.

Though often an incidental finding, heel spurs in certain cases can become critical to the evaluation and treatment of heel irritation. They may be the key to relief.

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By Dr. Kuvent, February 12, 2009 10:52 am

Most commonly, heel pain is caused by inflammation of the plantar fascia — the tissue along the bottom of your foot that connects your heel bone to your toes. The condition is called plantar fasciitis.
Plantar fasciitis causes stabbing or burning pain that’s usually worse in the morning because the fact that the fascia tightens overnight. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing, increased activities or after getting up from a seated position.

Plantar fasciitis usually develops gradually, but it can come on suddenly and be severe. And although it can affect both feet, it more often occurs in only one foot at a time. Be alert to; sharp pain in the inside part of the bottom of your heel, which may feel like a knife sticking in the bottom of your foot. Heel pain that tends to be worse with the first few steps after awakening, when climbing stairs or when standing on tiptoe. Heel pain after long periods of standing or after getting up from a seated position. Heel pain after, but not usually during, exercise Mild swelling in your heel

Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. But, if tension on that bowstring becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed. The causes of plantar fasciitis can be:

Physical activity overload

Plantar fasciitis is common in long-distance runners. Jogging, walking or stair climbing also can place too much stress on your heel bone and the soft tissue attached to it, especially as part of an aggressive new training regimen. Even household exertion, such as moving furniture or large appliances, can trigger the pain.

Arthritis

Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis.

Faulty foot mechanics

Being flat-footed, having a high arch or even having an abnormal pattern of walking can adversely affect the way weight is distributed when you’re on your feet, putting added stress on the plantar fascia.

Improper shoes

Shoes that are thin-soled, loose, or lack arch support or the ability to absorb shock don’t protect your feet. If you regularly wear shoes with high heels, your Achilles tendon — which is attached to your heel — can contract and shorten, causing strain on the tissue around your heel.